Stroke examination: Upper limb examination Flashcards
(16 cards)
What is the general order of an upper limb stroke examination?
Look at clinical signs
Muscle tone
Sensation: Dermatomes with light touch, vibration sensation, pain perception
Power: Myotomes
Reflexes: Biceps, supinator, triceps with tendon hammer
Joint proprioception (intention/action tremor)
Dysdiadochokinesia
Which clinical signs should you look for in an upper limb stroke examination? SWIFT
Scars
Wasting
Involuntary movements
Fasciculations
Tremor
Why should you look for scars in an upper limb stroke examination?
They can indicate previous spinal, brain or upper limb surgery or trauma
These could cause muscle and nerve injury
Why should you look for wasting in an upper limb stroke examination?
Muscle wasting is indicative of a lower motor neuron lesion (originate in brainstem or spinal cord)
Upper motor neuron lesions (originate in brain) don’t cause muscle wasting
What are fasciculations and why should you look for them in an upper limb stroke examination?
Involuntary rapid muscle twitches that are too weak to move a limb but are easily felt and seen
Indicate lower motor neuron lesion
Fasciculations don’t occur in upper motor neuron lesions
What is a resting tremor, and how and why should you look for them in an upper limb stroke examination?
Shaking that occurs when a body part is relaxed and supported against gravity
Ask patient to rest hands in lap and see if hands start shaking slowly and in rhythm, looks like someone is trying to roll a pill between thumb and fingers
Indicates damage to cerebellum or basal ganglia
Which 2 types of tremor should you look for in an upper limb examination?
Resting tremor
Holmes tremor
What is a Holmes/rubral tremor, and why should you look for them in an upper limb examination?
Irregular, low-frequency (slow movement) tremor that can be present at rest, during posture, and with intentional movement
Indicates stroke affecting thalamus, midbrain or cerebellum
When assessing tone in an upper limb stroke examination, which 3 muscle groups are being tested?
Shoulder
Elbow
Wrist
How do you test tone in upper limb stroke examination in 5 steps?
- Hold patients hand and elbow to support the upper limb
- Ask patient to completely relax their arm
- Shoulder circumduction: Move shoulder joint around in circles
- Elbow flexion/extension: Bend and straighten elbow joints
- Wrist circumduction: Move wrist joint around in circles
What are the 5 types of tone for you are checking for in upper limb stroke examination?
Hypertonia: Spasticity, rigidity, clasp-knife spasticity
Hypotonia
What is hypotonia, how do you identify it when checking tone and give 5 indicated conditions?
Hypotonia: Reduced muscle tone and ability to maintain posture
Upper limb is floppy and when release from hold it will hang straight down
Cerebral palsy, very recent stroke, hypoglycemia, congenital hypothyroidism, genetic conditions eg. Downs
What is hypertonia and what are the 3 types to look for?
Hypertonia: Increased muscle tone and ability to maintain posture
Spasticity (velocity-dependent): The faster you move the joint the more resistance there will be, so limb will feel stiffer
Clasp-knife spasticity: Sudden release of resistance at the end of a stretch, so limb goes very stiff then suddenly floppy
Rigidity (velocity-independent): Stiffness of joint remains constant throughout all movements
Which conditions are indicated by spasticity and clasp-knife spasticity?
Spasticity: Upper motor neuron lesions eg. spinal cord injury, multiple sclerosis, stroke, cerebral palsy
Clasp-knife spasticity: Stroke
Which conditions are indicated by rigidity?
Basal ganglia disorders eg. Parkinson’s, Huntington’s
Autoimmune conditions eg. SLE, fibromyalgia
How do you assess sensation in upper limb stroke examination
